Hot lap

The Hot Lap section of the Rollcage Medic site is where you can stretch your motorsport rescue and medicine muscles.

An event scenario will be posted and several questions posed for you to ponder. You can submit an answer either by using the DisqUs comments section below the scenario or by using the Rollcage Medic Google+ or Facebook page.

You can submit your own scenarios and questions as well ... just remember to send in the answers as well, just in case.

OK,
so it's been a while since I put up the very first Hot Lap case, but
hey, I do this stuff in my spare time so as much as I'd like to, I can't
guarantee I'll get one out every week. Anyway, on to the next scenario
and thanks to Andy Neill for sending me the link to the video.

You
are the Chief Medical Officer for the 2012 Pike's Peak International
Hillclimb and you are kicking back at race control enjoying some of the
action (I've never been to the Pike's
Peak Hillclimb race control so I've no idea whether this is even
possible, but allow me a bit of creative latitude), when you see this on one of the monitors:

A second live feed shows a bit more:

Oh dear!

Question 1

What are the dangers in managing this incident?

Question 2

What injuries would you suspect?

Question 3

How would you manage this incident?

.

.

The suggested answers are further down the page. You can go ahead and look, or, have a think about them first...

.

.

.

Answer 1

Scene

Spectators on the circuit approach

Other competitive vehicles on the circuit

The target vehicle is off circuit some number of metres down a
loose, rocky slope. Getting to it safely while carrying rescue and
medical equipment is likely to be hazardous

It looks like a hot day out there, which may be important if you or
your team have to spend more than a few minutes working on site

Vehicle

Risk of fire

Risk of vehicle slipping further downhill and injuring rescue team in the process

Casualties

Getting the injured competitors back to the medical centre is likely
to be difficult, especially if non-ambulant. there is risk of further
injury to them and to rescuers

Answer 2

Well, all of them probably! To
state the obvious, this is a BIG off. As the second video clip shows,
the various safety devices (rollcage, race harness, race seat,
helmet, deformable structures, etc) did their job and the driver walks
away apparently unhurt. But I'd be going to this expecting every type of
blunt injury from head to toe. There may also be penetrating injuries
if parts of the vehicle fracture near the competitor or invade the
cockpit.

At one point in both videos, the co-driver's helmet
appears to move outside the confines of the rollcage, which is always a
worry.

Bring everything to the scene for a kit-dump and be ready for anything!

Answer 3

Dispatch

Scramble
a medical response vehicle (first intervention medical and rescue
equipment and personel) and bring a second up on stand-by

Put an
alpha (ambulance) vehicle on stand-by and if neither the driver nor
co-driver were seen to move on the live monitor or from reports coming
back from local officials, consider scrambling the alpha and the second
medical response vehicle

Make sure that fire and rescue have
been scrambled to the scene also as these guys will protect your team.
Check either with the emergency communicator, the chief rescue official
or directly with the race director, who should all be in the same room
as you.

Start getting scene information fed back to you as soon as possible

Scene control

It's
likely that the race will be put on hold for the duration of the
rescue, but there may be other competitive vehicles on the stage

Make
sure any medical and rescue vehicles park defensively and if available,
display warning signs back along the competitive route. If no warning
signs are available, use any non-rescue official or spectators available
to flag down other vehicles so that they don't cause further incidents.

Establish a safe work area by using non-rescue officials or spectators to keep curious onlookers back

Make
sure that the vehicle's electrics have been de-activated (Kill switch
is usually between the front windscreen and bonnet and/or in the cockpit
on the centre console, where it is not always obvious)

Check for any signs of a fire and that the fire guys are on hand
and ready. If they are not available, you'll need to have your own
extinguisher with you (Yep, more stuff to carry)

If it's likely
that you'll be there for a while, try and put up a tarpaulin shade -
officials and spectators are good for this and the tarp should be part
of your kit

Vehicle safety

The fire and rescue team
will usually stabilise the vehicle, but if they are not available, you
might have to do this yourself. No point getting stuck into a trapped
competitor only to have the car slide further downhill, or rollover on
top of you. We'll look at chocking methods another time.

As
above, make sure that the vehicle's electrics have been de-activated
(Kill
switch is usually between the front windscreen and bonnet and/or in the
cockpit on the centre console). It also helps to know where the fire
suppression system activating button is, just in case. In some vehicles,
the electrics kill-switch and fire suppression button are one and the
same.

Watch for broken plastic, glass and carbon fibre

Watch for hot vehicle elements

Competitors

Rapidly perform a primary survey to identify the management priorities.

Make
a rapid assessment of whether an emergency extrication is needed
(immediate clinical or environmental threat to life such as a cardiac
arrest or the vehicle is on fire). Otherwise, a planned extrication
should happen once practical.

Clinical management should occur
along EMST/ATLS pathways with attention to airway protection, supported
oxygenation, cervical spine control and haemorrage control (MARCH
pathways put control of massive haemorrage up front). Do only what is
required to facilitate a safe transfer to either the medical centre or
to the receiving hospital.

Removal of the helmet and head and
neck restraint device will usually be required and may have to be done
while the casualty is still in the vehicle if there is entrapment by
confinement or compression, or if the person's injuries limit their ease
of extrication.

At the same time, an extrication plan should be formulated between the medical and rescue teams.

There
should be constant communication between the team at the scene and race
control so that necessary resources can be rapidly deployed and a
streamlined extrication and transfer can occur. This bit is often
underestimated!

Disposition

Depending upon the
set up of the event, the default is often a transfer to the medical
centre for stabilisation and further assessment and then subsequent
transfer to a receiving hospital if needed. Some events have a suitable
trauma hospital nearby and so may have a plan in place that all
significant traumas go directly from the scene to th hospital, either by
road or by air.

Luckily for the driver and co-driver of
this incident, they were both unharmed and no doubt will be back racing
after a stiff drink and a good back rub.

Please feel free to leave any comments or bits of experience you've had.